During my observership i went into the spinal cord ward where patients with spinal cord injuries learn to live a new life with some different rules. I guess such injuries push people back to their beginnings as children. They need to learn new skills, strengthen them by practice and accept someone else’s help.
At this time what people say can and does make a huge difference. And if the patient requires long term treatment you must remember how to approach them in the many facets of interaction which include coaxing, forbidding, informing, and sometimes arguing. That is because long term treatment seldom shows quick results. There are many approaches that i observed in the doctors that seemed most at ease. These doctors command the patients respect because they know most of the time what the patient wants to hear. That does not mean they are conciliating. All patients respect decisiveness in the doctor they consult, whatever their mood.
Some patients, mostly the new entries are quite sensitive. With them the doctor encourages them to talk and doesn’t say much because they require sympathetic listening and tact. People tend to overdo sympathetic ‘reaching out’ sometimes so patients are soothed by unembarrassed audience.
The old patients, that is some of them, accept their condition so completely that doctors’ approach border on indifference to errr finer feelings. Not indifference to their well being, simply a tactful jocularity. These greet people happily, are curious, and in general out going. One such patient cheerfully allowed my facilitator to do examinations on him to teach me the sequence of procedures. He even corrected me as i did them over under my facilitator’s eye. Doctors rib these patients sometimes but always maintain mutual respect. Not all patients are like that though and some have to be handled with gloves literally. Some also exaggerate and complain illogically. These patients require the most patience, sympathy and firmness.
Strangely, pity really has no place in PM&R. it is a dynamic field that does not condone crying over split milk or pessimism. The doctors i saw working with cerebral palsy patients were jubilant over improvements, critical of inattention or neglect to follow instructions, or concerned for the patient. I believe they would have been irritated if someone had exhibited distress over their job or the children they dealt with. Perhaps they know that pity may lead to parents and patients giving up. And that is discouraged by the unquestioning acceptance of limitations of the disease and the attitude ‘ what are we going to do about it?’